A 50 year old truck driver has been diabetic and has required

insulin therapy for the past 20 years. Diabetic neuropathy has led
to several complications, including end stage renal disease,
which he developed two years ago. He now receives
hemodialysis 3 times a week and has an AV fistula in his left
forearm. Yesterday, C.S presented in the ER with respiratory
infection and was hospitalized with pneumonia, hypertension,
and fluid overload. He will receive dialysis while on your nursing
unit. 

1. Is is appropriate to administer an aminoglycoside antibiotic

for his respiratory infection? Why or why not?

Aminoglycosides are used to treat gram negative infections and

eliminated through the kidney which is not metabolized. The half life
of drug is 2- 3 hour in a normal adult. But half life is dramatically
increased in renal patients as it excreted through kidney. To reduce
further complications, the dosage should be reduced or increase the
dose interval in patients with renal failure.

2. What changes would you expect to see in this client's blood

glucose levels duing and after hemodialysis?

During and after the hemodialysis, the patient may develop

hypoglycemia.

Nursing care during hemodialysis

*Monitor the vital signs

*Maintain aseptic technique during the procedure

*Monitor the weight

*Assessment of fistula site

*Management of bleeding
Nursing care after hemodialysis

*Screening of blood sugar levels

*Weight monitoring

*Vital signs assessment

*Fluid intake restrictions

*Assess the fistula site

*Documentation of the procedure

3. C.S missed his dialysis treatment on the day of admission.

How might this be evidenced in his respiratory status? 

Patient is suffering from pneumonia. Missing his dialysis may lead to

fluid overload, which resulted in CHF and pulmonary edema.

Diuretics should be administered to prevent fluid overload. Arrange

hemodialysis for the patient as per physician's order.

4.His wife comments on his fruity odor of his breath. What

complication would cause this sign?

Fruity breath is due to metabolic acidosis. Patient also experience

with malaise, headache and abdominal pain .

To prevent further complications of metabolic acidosis, monitor the

serum bicarbonate levels of the patient. Metabolic acidosis in patients
with renal failure treated with sodium bicarbonate is safe and well
tolerated.
5. C.S complains of dry, itching skin. How would you explain this
symptom to him? What nursing measures for skin care would
you provide? 

In renal failure, the kidney is unable to excrete waste material from the
body and it leads to dry skin and itching of skin. It common in
patients with kidney disease. To prevent itching skin, use high fat
soap and lotion, control phosphorus intake, and benadryl.
6. List 3 nursing diagnosis, interventions, and patient teachings. 

Risk for Injury Monitor temperature. Note presence of fever

chills, hypotension.

Deficient Fluid Volume Weigh daily before and after dialysis.

Excess Fluid Volume Monitor serum sodium levels. Restrict sodium

intake as indicated.

7. What is hemodialysis and name 3 side effects and patient

teaching in reference to hemodialysis?

A procedure where dialysis machine and a special filter or a dialyzer

are used to clean the blood is called Hemodialysis.
The 3 side effects of Hemodialysis are:
1. Low blood pressure.
2. Cramps in muscles.
3. Sleeping problems.
4. Anemia.
5. Diseases related to bones.
The patient should discuss the risks and benefits of the dialysis with
the provider. The patient should discuss with the clinicians about the
possibility of getting a kidney transplant. Further, the patient should
have education on low sodium and potassium diet.
8. What medication therapy is limited by kidneys inability to
excrete?The medication therapy which is limited by kidney
ability to excrete includes methotrexate, lithium, enoxaparin
and metformin.

9. What lab values would indicate the kidney is not functioning

well?The lab values which indicates that is kidneys are not
functioning properly is the Creatinine level, which is greater
than 1.2 for women and for men greater than 1.4 are the early
signs of the kidneys that are not working properly.

10. What are the clinical manifestations of end stage renal

dialysis (ESRD).  

Clinical manifestation of End-stage renal disease, is that the

kidney does not work properly as they should actually work
for the body. The kidney filter wastes and excess fluids from
the blood, and then are excreted in the urine. For the end-
stage renal disease, dialysis or a kidney transplant is
required to stay alive.
At the final stage, the patient may have symptoms of fatigue,
drowsiness, inability to pass urine or decreased urine, weight loss,
nausea, pain in bones, nail and skin changes.